Long-acting Ca-blockers were not ass'd
w/increased risk for a major CV event (OR 0.76) but
short-acting agents were (OR 3.88) in a case-control
study of 189 pts with a first cardiovascular event and
189 controls matched for age, sex, and length of f/u.
(Lancet 349:594, 1997-JW)

470 pts with NIDDM randomized to enalapril vs.
nisoldipine with equivalent BP control in both groups; at
5y, sig. greater # of MI's in nisoldipine group (25 vs.
5)--RR of MI was 7.0 for nisoldipine after adjustment for
risk factors (NEJM 338:645, 1998--JW)

Among 14,000 women 30-55yo with HTN in the Nurses' Health
Study followed x 6y, Ca-blockers ass'd with RR 1.64 for
MI c/w tx with diuretics alone, after controlling for
other risk factors for MI; summary also alludes to
"increased risk for total mortality among Ca-channel
blocker uses." Note that the study period ran from
1988-94 so may not have included much use of long-acting
Ca-channel blockers (Circ 97:1540, 1998--JW)

Amlodipine use (for avg. 5-16wks) and long-acting
nifedipine use were not ass'd with sig. diff. incidence
of CV events c/w placebo, in a review of clinical trial
databases of Pfizer (Am. J. Cardiol. 81:163, 1998)

(Source: Med. Letter 39:14, 1997 & others as cited-they
conclude that pending randomized controlled trials, "short
acting Ca-channel blockers, particularly nifedipine, should not
be used for treatment of HTN...pts taking a short-acting
Ca-blocker for HTN should probably switch to a long-acting
formulation" Also recc. beta-blockers or nitrates over
Ca-blockers for angina)

II. Risk of Cancer:

Breast: the Cardiovascular Health Study looked at a
cohort of 3200 women > 65yo who were given annual
questionnaires re: health status and medication use. Use
of Ca-channel blockers was ass'd w/a hazard ratio of 2.57
(sig.) of hospitalization for breast Ca c/w
non-users. The association persisted in comparison
w/other antihypertensives. No associations found between
use of other antihypertensives and breast Ca. The authors
hypothesize that the mechanism is interference
w/apoptosis (programmed cell death) due to interference
of Ca-dependent endonuclease (Cancer 80:1438, 1997-read
abstract and part of the paper)

However, a case-control study comparing 9500 pts 40-69yo
admitted to a hosp. with Ca and 6500 control admitted for
other causes; no difference in overall risk of Ca or any
of 23 individual Ca's, except for renal Ca (but similar
increased risk w/use of beta-blockers or ACEI's; JAMA
279:1000, 1998--abst)

Also, another prospective trial of 11,500 pts with CAD
followed for avg. 2.8y, no assn w/use of a Ca-channel
blocker and risk of developing Ca; also no assn' between
use of Ca-channel blocker and risk of death